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Parcel 006-1021-80-100 01/23/2007 03:50
PAGE 1 OF 1
F 1
Alt. Parcel 10.31.16.139B 006 - TOWN OF CYLON
Current X_,' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MERSHON, RICK & LISA
RICK & LISA MERSHON
2309 CTY RD H
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2309 CTY RD H
SC 1127 CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 20.520 Plat: N/A-NOT AVAILABLE
SEC 10 T31 N R16W 20.52AC W 677' OF THE Block/Condo Bldg:
NW NW (FKA LISA M CODY)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
10-31 N-1 6W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 994/374 ac
07/23/1997 870/272
782 - os
2006 SUMMARY Bill Fair Market Value: Assessed with:
144303 Use Value Assessment
Valuations: Last Changed: 07/26/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.520 10,000 317,500 327,500 NO
AGRICULTURAL G4 4.000 600 0 600 NO
AGRICULTURAL FOREST G5M 8.000 9,600 0 9,600 NO
MFL BEFORE'05 CLOSED W8 7.000 16,800 0 16,800 NO
Totals for 2006:
General Property 13.520 20,200 317,500 337,700
Woodland 7.000 16,800 16,800
Totals for 2005:
General Property 13.520 20,200 317,500 337,700
Woodland 7.000 16,800 16,800
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
S
• Form-STC- 104
a
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP , SEC. T, N-R~W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT ; LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3
' IACAL
E
s-~r' dr r
/d8
r~
INDICATE NORTH ARROW
r'
BENCHMARK: Describe the vertical reference point used -41 Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: 1_"3**,,:.;)'r'.J~iquid Capacity: &44 !2,y-
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: zy'
Number of feet from nearest Road: Front, Side, 0 Rear, OS feet
From nearest property line Front ,Q)Side,0 Rear, O feet
i
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: y Trench:
Width: y Length: G Number of Lines: Area Built:_
I/
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, Rear,O Ft.t
Number of feet from well: 1
Number of feet from building: 70 4W660
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number :
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969' BUREAU OF PLUMBING
MADISON, t*I 53707
CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIY HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Florence Friedrick RR, Deer Park, WI 54007 J_ 9 40!l I0 dot./
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV..
NW NW, Section 10, T31N-R16W, Town of Cylon
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Cal Powers 1563 St. Croix
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PRO IDED. PROVIDED:
100. YES ❑NO ❑YES %0'
POIJ mn
0 ~
BEDDING: VENT DIA.: VENT MAT L.. HIGH WATER NUMBER ROAD: PR OP ERTY WELL: BUILDING: IVENT TO FRESH
ALARM: L 5,3 L II AIR INLET
❑YES NO FEET FRLSD
C ❑YES ❑NO N~ LSD Z
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. JPUMP/SIPHON MANUF TUBER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO if I ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBJFOM OF PROPERTY WELL. BUILDING. IVENTTOFFIESH
(DIFFERENCE BETWEEN FEET LINE AIR INLET:
PUMP ON AND OFF) ❑YES ❑N NEAR T
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing TH JDIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH TRENCHES JDISTR. PIPE SPACING. COVER INSIUE DIA.. *PITS. LIQUID
AL: PIT DEPTH:
TRENCHES 6- MA
DIMENSIONS `
GRAVEL DL- iH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVER. V. INLET E V END 2 2 C PIPE' FEET FROM L r7 A~L~
02 S 3G~~i i NEAREST--s Oj 7
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
Lr- OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED SEEDED: MULCHED.
R. EDG ES:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
1W, DTH: LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
IMANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV.. CIA.. ELEV.: PIPES. DI A.:
ELEVATION AND .
DISTRIBUTION
INFORMATION r7l HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
:
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
I
Sketch System on Retain i county file for audit.
Reverse Side.
SIGNATURE: ~ TITLE:
DILHR SBD 6710 (R. 01/82)
t
w'S`°nsin APPLICATION FOR SANITARY PERMIT
OUNTY
DILHR (PLB 67)
~'l~~ °ERaRnnEnTOV UNIFORM SANITARY PERMIT #
InDUStRV, LRB°R 6 Human RELRTI°ns
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
PROPERTY LOCATION CITY:
O/4 /4, S , T31, N, R or) W TOWN OF: C)
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ROAD, AKE OR LANDMARK STATE PLAN I.D. NUMBER
AVA
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
AN Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: W
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
35 0
Q //d`5 VPrivate ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Namej Plu ber (P n Signa MP/MPRSW No.: Phone Number:
t~4 u w~ ~I F~~
5G~.3 ( 743 ~ 516 5/,35
Plumber's Address: Name of Designer:
6
lgiwcw~(f_ 06, COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
62A"~404 Of q` fiL ❑ Owner Given Initial
• Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SB0-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
G~
y
.r
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398,
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
z
APPLICATION FOR SANITARY PERMIT
ST C- 100 ;
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor.,("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property F/o P a c e- ~r6 4 hl G~
Location of Property &&-14 _~4, Section ld T T N - R W
Township
Mailing Address
Subdivision Name ,
Lot Number
~ J
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes_ No
as recorded with the Register of Deeds
Volume aoand Page Number 421 b7
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
PROPFRTV OWNER CERTIFICATION
I (We) ceJti6y that att statement-6 on th,%b bonm ane tAue to the bat a6 my (our)
knowledge; that 1 (we) am ( are ) the owner (s) o j o petty dea cn ibed in thus
in4mmat on jonm, by viAtue o~ a wa Aant ed the 066ice ab the
Count Register o~ Deeda as Documen - a ,3 lull 1 _ d that I (we)
. p
pnebyenemy awn the pna pobed site ~an age osaeystem (on I (we) have
obtained an eaaement, to nun with the above deactibed pnapetrty, 4on the
constAuc,tion a4 said system, and the ~6ame ha6 been duty tecotded in the 064ice
ob the County Regis-ten o4 Deeda, ass Document No. )
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
\a.2ttA. \1 a ar+t r - . i Wife
ed
Tbiz hibenturep Made this 3rd day of November
between Arnold Friedrich and Florence Friedrich, his wife, Haze,
-,Thompson and Edna Friedrich
•s
part i e s of the first part, and
nrnold Friedrick arid' Florence Friedrich
husband and wife, as joint tenants, parties of the second part,
dIitntoo ft That the said part ies of the first part, for are, in consideration of the sum of
One ($i-00),pol3ar and other valu.w; le consideration Dollars,
to them in hand paid . by the said parties of the second part, the receipt whereof is hereby
confessed and acknowledged, ha ve given,' granted. bargained, sold, remised, released, aliened, conveyed
and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and
conSrtn unto the said parties of the second part, as joint tenants, the following described real estate
situated in the County of Et. Croix , Wisconsin, to-wit:
j The `,hest Half of the Northwest _uarter the L'outh-
east ;quarter of thf Northwest quarter and the
Northwest ,uarter of the uJUtlaireztt quarter (INVIZEN ) all in s§
erection Number Ten (10), -Townsh: p Numbclr Telirty gore (31)
North, of Range Number + ixteen (16) West; ~
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Ceptjim with all and singular the hereditaments and appurtenances thereunto ~elonging or in anyw im
apperiaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part i e:
of the first pan, either is law or equity, either in possession or expectancy of, in and to the above bairgWa"
premises, and then hereditements and appurtenances.
4U-JeUr attb to 41010, the said premises as above described with the'hereditaments and appurtenances.
anta the said ,parties of the second part, as joint tenants.
: aftb -t ggo, Arnold Fri edri ch, et al
parties of the first part, for th ern s e 1 v e-, their heirs, executors and administrators,
do covenant, grant, bargain and agree to and with the said parties of the second part, and to and
with the survivor of them, his or her heirs and assigns, that at the time of the ensealing and dellversr art
e premises
these presents they are well seized of th above described,
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
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OWNER/BUYER EZ6r_-e_ lGae= r~~e~ri~ltC r
ROUTE/BOX NUMBER Fire Number
CITY/STATE e- ZIP.S~10as
PROPERTY LOCATION: (J~ !4, Section lb , T_ 1 N, R W,
Town of /OYk , St. Croix County,
Subdivision V Lot' number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into II
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
0
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- ro
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date. ,p
S I C N E D,; IIz
..DATE L/GGL . 26~`'li~
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND. SAFETY & BUILDINGS
INDUSTRY, _ DIVISION , DIVISION
INDUSON
LABOR AND PERCOLATION TESTS (1151 P. -Ilm-G
HUMAN-RELATIONS \ / MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISIJON `l1'/
4/4 /T 3l 7N/7R///44 $(or) W C o
COUNTY: , OWN++ER'S BUYER'S NAME: MAILING ADDRESS:
.S't Croo l N, 1 O Y~
USE
DATES OBSERVATIONS MADE
NO.BEDRMS,: COMMERCIAL DESCRIPTION: PROFILED C PTIONS: LA ON TESTS:
WResidence 3 ❑New V~Re lace
RATING: S= Site suitable for system . U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GRO ND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:joptional)
KS DU [~1S DU S DU DS d31U ❑S ~U ('OA Je , an
[under Percolation Tests are NOT required DESIGN RATE: [Floodplain, f an
N y portion of the tested area is in the O
s.H63.09(5)(b), indicate: indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST: HIGHEST TO BEDROCK IF BS RVED I EE ABBRV. ON BACK.)
B- / M a rn e
9q~~ 1913 6-41`!
B.IB _
B- a ' 7t. O BKS. I 316 A S
B- el 9$~ D > /i 72 atstlj -"2 °"S,/ &(L S/ 31 J' 1r" hf/e ?8►1
8K 9- 33 s ' 3,7 -64 A s ± r
B-
B-
PERCOLATION TESTS
TEST DEPTH. WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R D PER INCH
P- 2 a~ ~.L 7 _3S
P- 3 APO
P-
P-_
P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all 'borings and the direction and percent
of land slope.
SYSTEM ELEVATION S• a
7P
W • i
E
E I :
H
45 z
:E E
:
ArLi
1 t
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (pri
/0r~ o6V_e r~ TESTS WERE~COMPLECTlED ON:
ADDRESS: /J" r
CERTIFICATION NUMBER: PHONE NUMBER(option~a+l):
CST S A R E
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
i
INSTRUCTIONS FOR COMPLETING FORM 115 - SRC - -395 '
Try ! a con I accurate sail test,Yoarr report must include:
1. I e-:;cription;
2. 1 gust clearly indicate 7 sther this is a residence or commer. :t;
1 er of I drooms ~iercial use planned;
sy_--
)a SITE IS SU - ELE FOR A HOLDING TANK ONLY IF ALL
ASED C L CONDITIONS;
6. ~-e fc.. v c~ scriptio is c pletinq the plot plan;
7 locatin y locations. D srile is preferred. A
i i1evation rs point are rr-nanent;
<< : as to dates, names, ~ Idi =s, flood plain _ ";t exemp-
_,ain, elevations (4, lyr, place. N.A. i ;x;
address am `i ' :tiara numkre
ai : requires _.)IL TESTS IV'll uT FILED WITH THE
YS O
,,,TYWITH,
-VIA1 JR CERTIFIED SOIL TEv.
Textures, Othe Cx .'gals
Cq -
L r am
Gy
Y
R
mot -
vV/
fff -
s~
Cc.
rrrrn -
d -
p -
F#W L
'l
BM
VRP - Ver
.
TO
E
-%J
J
` RQ~ ZJZS~JITcaJ~ t.J PAGE OF
s CroSS ale
Fresh Air Inle,s And Observation Pipe
J j- Approved vent Cap
Minimum 12" Above
Final Grade
I
20 - 42" Above Pipe _ 4" Cost Iron
To Final Grad• Vent Pipe
Ma'eh Hay Or Synthetic Covering
- min 2" Aggregate
Ova' Pipe
Distribution
pipe 0 0 0 0 -Too
6" Aath Pipe a
Perforated Pips Below
Beneath Plpe
0 -Coupling Terminating At
Bottom Of Syclem
~
Propose D Pin-1 grc.cl-t q81
~~tJ•.+ toll
SOIL FILL
DISTRIBU'r1OC'•1 PIPE
APPROVED S'IpITNETIC COVER
° MI►TEIiIgI OR 9" OF STRAW
Z"oF~6GR~GATE OR MARSU HAJ
plC 4o' 0 FAGGREGATE
r,L.EV. OF J FEET
3 3
lam--- fo 3
DIS-rRiBJTIOtJ PIPE TU BE AT LEAST WCHES BELOW ORIGIIJAL. GRADE
AMU AT LEASTPO IIJCHES BUT AIO MORE THA1J H2 IAICHES BELOW FINAL GRADE
MNXIMUM ®EPrH OF EXCAVATI(DO F014 oKi&N.L 69AIM WILL BE FICHES
MIN)MUM ®irprh OF EACAVATION FP\0^ 01KI61WALGRAVE WILL BE a0 INCHES
SIGHED:
LICEMSE AJUMBER: ~-1 _5
I
DAT E
G „o
- -id
~d !o
o
l
a
q -
I I I ~
I~~Li i1~rtt TTY +i Ti
i ~ r+~ ~ ~ ~I ~ ~ ~ - ~ ~
J_Ib ~rt ~'~iT i~__ Tt Ii
~-rt -I i Ali
fi~ ~I H ~ ~ ~ - = I I~ i r I i fi
4/77-92
ST. CROIX COUNTY ZONING OFFICE
/ St. Croix County Courthouse
911 4th Street
q( Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form Ja essential ZQ that tag property can Dg
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received..
WATER TESTING-----------------------------FEE: $ 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.00
(For VOCIS)
SEPTIC SYSTEM INSPECTION FEE:. $25.00 V
(Determines if system is properly functioning at.time of
inspection)
PROPERTY OWNER'S NAME: 1 SCE Rs n
PROP. ADDRESp S : CITY -1-)'0'e R
Legal De ritio 1/4 of the 1/4 of Section (6T _N-RAO
Town of Lot'Number Subdivision:
LOCK OX NUNBER ~ - ~Q o? /-A -0'3/ f 3 ~ L~
FIRE NU D-
Color of house C~_.~► Realty sign by house?=If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBL$, A KAP,i.e,COPY OF PLAT HOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER .TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to thehome necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
or individual r questing services: 15
ne Number )
REP
~ j O SENT TO: _
F^
AL.
~'EG-SIN ATE:
i. i ~i.
ig at
cO~
CF
-
CYLON
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10 ST. CROIX COUNTY
WISCONSIN
r~
S? ZONING OFFICE
x ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
October 14, 1992
Lisa M. Mershon
2309 Co. Rd. H
Deer Park, WI 54007
Dear Ms. Mershon:
On October 13, 1992 an onsite inspection of the septic system was
conducted on the property located at the NW 1/4 of the NW 1/4 of
Section 10, T31N-R16W, Town of Cylon. By visual examination no
failure was seen. No digging or excavation was done. In review of
the Soil Survey of St. croix County, questionable soil for onsite
systems are seen in the entire area. Even though a soil test was
conducted in 1984 showing a suitable site for system installation,
an da system was installed on November 11, 1984, it is the
recommendation that a single soil boring be conducted in the system
area to verify soil suitability. This must be done by a certified
soil tester, and the results reported to the Zoning Office. if the
report is acceptable, a sanitary permit to connect the system to
the new residence must be issued from this office.
Please have your plumber contact us to obtain this permit. I have
enclosed two forms required to be completed by the property owner
in order to issue the permit. You must also furnish a copy of your
deed. Please give the completed forms and the deed to your plumber
to bring to the Zoning Office.
If I can be of further assistance, or if you have any questions,
please contact me.
Si cerely,
Mary J.'Jenkins
Assistant Zoning Administrator
cj